Agitation and Irritability in Alzheimer’s Disease: Evidenced-Based Treatments and the Black-Box Warning

  • Aaron M. KoenigEmail author
  • Steven E. Arnold
  • Joel E. Streim
Geriatric Disorders (W McDonald, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Geriatric Disorders


More than five million Americans suffer from Alzheimer’s disease (AD), and this number is expected to triple by 2050. While impairments in cognition, particularly memory, are typically the defining features of the clinical syndrome, behavioral symptoms are extremely common, affecting up to 90 % of patients. Behavioral symptoms in AD can be difficult to manage and may require a combination of non-pharmacological and pharmacological approaches. The latter is complicated by FDA “black-box warnings” for the medication classes most often used to target these symptoms, and currently there are initiatives in place to limit their use. In this review, we describe common behavioral symptoms of AD—with a particular focus on the challenging symptoms of “agitation” and “irritability”—and discuss evidence-based approaches to their management. Ultimately, multidimensional approaches must be tailored to the patient and their environment, though evidence-based practices should define the treatment of agitation and irritability in AD.


Alzheimer’s disease Neuropsychiatric symptoms Pharmacological approaches Non-pharmacological approaches Black-box warning 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no competing interests.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


This work was supported, in part, by National Institutes of Health grant T32 MH1711929 (AMK).


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Aaron M. Koenig
    • 1
    • 2
    Email author
  • Steven E. Arnold
    • 3
    • 4
  • Joel E. Streim
    • 5
    • 6
  1. 1.Department of PsychiatryMassachusetts General HospitalBostonUSA
  2. 2.Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonUSA
  3. 3.MassGeneral Institute for Neurodegenerative DiseaseBostonUSA
  4. 4.Department of NeurologyMassachusetts General HospitalBostonUSA
  5. 5.Department of PsychiatryUniversity of PennsylvaniaPhiladelphiaUSA
  6. 6.Behavioral Health ServiceCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaUSA

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